BCBS of Louisiana throws up obstacles to insurance coverage for HIV/AIDS patients; could this be another ploy by Jindal?

First Gov. Bobby Jindal refused to expand the state’s Medicaid program and then he vetoed a $4 million appropriation aimed at shortening a waiting list for home-based services for the developmentally disabled.

And now there is this:

“AIDS patients in Obamacare limbo as insurers reject checks.”

That was the headline on the Reuters story that moved on the Internet at 9:23 a.m. on Saturday. The upshot of the story was that hundreds of HIV/AIDS patients in Louisiana attempting to obtain coverage under the Affordable Care Act are in danger of being rejected by the insurance plan they selected.

Just as significant is the roar of stony silence emanating from the State Capitol’s fourth floor office of Bobby Jindal who, six years ago first swore an oath to uphold the rights of all the citizens of Louisiana—even those several hundred adversely affected by the latest BCBS decision. Some would even speculate that Jindal may have leaned on BCBS, which holds two contracts worth $1.1 billion with the state through the Office of Group Benefits.

Others might even raise the question that if Jindal did influence the decision, did he do so at the behest of the Louisiana Family Forum?

The issue revolves around a dispute over federal subsidies and the interpretation of federal rules about preventing Obamacare fraud

BCBS, the state’s largest carrier, is rejecting checks from a federal program that is specifically designed to assist HIV/AIDS patients in paying for AIDS drugs and for insurance premiums under the Ryan White CARE (Comprehensive AIDS Resources Emergency) Act.

Ryan White, a hemophiliac from Kokomo, Indiana, was diagnosed with AIDS at age 13 from a contaminated blood transfusion. He and his mother Jeanne White Ginder fought for his right to attend school. He died in 1990 at age 18, a month before his high school graduation and only months before Congress passed the act that bears his name.

The Ryan White Program is the single largest federal program designed specifically for people with HIV and benefits more than half a million patients each year. It provides care and support services to individuals and families affected by the disease, serving as the “payer of last resort” by filling the gaps for those who have no other source of coverage or who face coverage limits.

But now, inexplicably, BCBS says it will no longer accept third-party payments such as those provided by the Ryan White Program.

“In no event will coverage be provided to any subscribers, as of March 1, 2014, unless the premiums are paid by the subscriber (or a relative) unless otherwise required by law,” said BCBS spokesman John Maginnis (no, not the journalist).

The decision stems from a series of communications from the Centers for Medicare and Medicaid Services (CMS), the lead Obamacare agency. In September, CMS informed insurers that Ryan White funds “may be used to cover the cost of private health insurance premiums, deductibles and co-payments” for Obamacare plans.

But in November, CMS warned care providers and “other commercial entities” that because of the risk of fraud, it had “significant concerns” about their supporting premium payments and assistant Obamacare consumers pay deductibles and other costs.

BCBS seized on that to say it had implemented a policy, “across our individual health insurance market, of not accepting premium payments from any third parties who are not related” to the subscriber, according to Maginnis.

Not so fast, says CMS. “The third-party payer guidance CMS released (in November) does not apply” to the Ryan White programs, it said.

Hundreds of HIV/AIDS patients who are not eligible for Medicaid depend on Ryan White payments for Obamacare. That is because Gov. Bobby Jindal chose not to expand the low-income Medicaid program and Obamacare federal subsidies do not kick in until people are at 100 percent of the federal poverty level.

The only other carrier currently refusing to accept such payments is BCBS of North Dakota, according to a CMS spokesperson but that policy is currently under review.

Jessica Stone, a member of U.S. Sen. Mary Landrieu’s staff, in an email to health care advocates, wrote, “BCBS LA told me their decision was not due to the CMS guidance or any confusion (as we thought before) but was in fact due to adverse selection concerns” in an effort by insurers to keep AIDS patients from enrolling in their plans.

Adverse selection refers to the situation where an insurer attracts patients with chronic conditions and expensive care. John Peller, vice president for policy at the AIDS Foundation in Chicago, said the action “sure looks to us like discrimination against sick people.”

One observer said it shouldn’t matter who pays the premiums. “All the insurer should care about is whether the premiums are paid or not. I once loaned money to a friend and had problems getting him to pay me back. His girlfriend finally paid me some of the money. If I had been like BCBS, I would have refused her money, preferring to get it from him—and I would have gotten nothing. This makes no sense whatsoever.”

Perhaps Jindal intends to ignore the 13,400 HIV/AIDS victims served by the program in Louisiana and use the $50.7 million in Ryan White funds the state receives to help plug next year’s all but certain budget deficit.

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18 Responses

Looks like the Ryan White fund needs to pay the insured directly, then they are free to purchase their insurance. Problem solved. Of course this will cost the Ryan White fund a lot more money. Shame on BCBS.

Bingo. However, as Hillary Clinton pointed out, the upfront costs scare people off despite the long term savings we would ultimately see in addition to universal coverage, instead of our current piecemeal care that is inefficient, ineffective, and unfair. Our state and nation are short-sighted and we can only assume the Republican philosophy is: Health care for those who can afford it, to heck with everybody who can’t – they just need to work harder.

Governor Jindal is on a fast pace to destroy so much progress in regards to treatment for HIV and AIDS patients. But first let’s look at some cold hard facts by a reliable source, CDC.gov tracks HIV cases and AIDS everywhere. Fact: According to CDC,” 1.1 million people in U.S. Are living with HIV and one in six do not know they are infected.” Review Baton Rouge Advocate on archives with. Baton Rouge having the highest rate of new cases of HIV in an urban area the size of Baton Rouge. Baton Rouge and New Orleans, Louisiana are in top five of of hardest hit areas. Number of new infections are males between the ages of 13-24 and 55 % are young black males.(CDC, 2011).
This is not an ACA outcome but a decision for Louisiana to go backwards to the days when treatment was scarce and the mortality rate close to 100%. But thanks to hardworking scientists and people all over who had loved ones die pulled together and put forth research funding and found a miracle drug concoction so HIV patients could live long lives and AIDS avoided.
I among many Louisiana folks from all cultures, race, gender, worked tirelessly to raise money, educate the public and now Jindal wants to find a crazy way to spin BCBS role, Ryan White Federal law(read his story) schools denied him an education because of the rampant fear of the, ” AIDS epidemic at the time when it was so poorly misunderstood and despite the facts brought forth of the spread of the disease by the medical community, people who suffered from AIDS or HIV positive were cast aside as Lepers.
How can anyone forget those horrible times and all those deaths? I think this article reveals some very scary and disturbing undertones of racial cleansing, and Jindal’s desire to rid the state of the , “undesirables, as I guess he eludes to in his private quarters.” Sadly, people will fall for it and jump on board the train which if looked at closely enough may resemble the cattle cars used during the Holocaust. Careful, no one is exempt from contacting HIV. Students in Baton Rouge and New Orleans who don’t fit the profile of the cleansing tactics look just like your next door neighbor. Your daughter, your niece or nephew, in other words HIV does not discriminate.
Read Jindal article attacking President Obama on Politico titled, ” Obamacare is not compassionate.” On today’s website. Now Jindal can only criticize Obama because any fool who follows Jindal’s Gestapo tactics, you know rule by fear, fire you, discredit you in your community, strip you of your rights, convince you he knows best, which is by far the most ridiculous. May God save us from such evil masked in lies. We know he lies because he accuses someone else lacking compassion. Compassion is something he knows nothing about. Thank you for the article. Disheartening is not close to how low these latest tactics are.

I don’t understand the problems that BCBS-LA is having with this; I’m just guessing but since the Ryan White CARE Act is federal, wouldn’t these checks or payments be federal checks? I’m more than certain that they are more than willing to take any federal funds for other plans. Why just single out the individual market if it’s not “adverse selection”? CMS wields a might big stick when it comes to paying for medical care. BCBS LA would be wise not to lock horns with them, they aren’t going to win.

or the obligation to pay a certain percentage of premium dollars towards claims, that they take issue with?

If BCBS does that, then they will be (once again?) running afoul of federal law which requires that they have to spend “x” amt. toward claims and not as admin overhead.

Oh here we go: It’s the 80/20 rule:

80/20 Rule

The 80/20 Rule generally requires insurance companies to spend at least 80% of the money they take in on premiums on your health care and quality improvement activities instead of administrative, overhead, and marketing costs.

The 80/20 rule is sometimes known as Medical Loss Ratio, or MLR. If an insurance company uses 80 cents out of every premium dollar to pay for your medical claims and activities that improve the quality of care, the company has a Medical Loss Ratio of 80%.

Insurance companies selling to large groups (usually more than 50 employees) must spend at least 85% of premiums on care and quality improvement.

If your insurance company doesn’t meet these requirements, you’ll get a rebate from your premiums.

The “boy Genius”, “Healthcare Guru”, Bobby Jindal should get involved immediately in requiring BCBS to cover these citizens. If there is no insurance coverage for up-front healthcare, will the lack of medical treatment for these patients not cost the state untold millions of dollars more than what we are currently spending. After all, the healthcare costs for the tertiary care they will be receiving will be borne by the state’s new “Charity Hospital System?” I didn’t mention anything about the prevention of the physical suffering or undue worry the governor could prevent by assuring all he will make sure the right thing is done. If he did care, he would have already become visibly involved.

The Jindalites and their leader Teepell, are against anything “federal government” and this is just another add on or overreach of their strategy to get it all screwed up, and get all, repeat all of our tax money in the hands of corporate America, just another book of business by the guru. I agree that Tony Perkins and the My family only forum, along with Rodney Alexander at LDVA are team cheerleaders and will ignore the law, the Constitution, and truly in their immoral religious beliefs could care less about sick people(that is, until they can get that book of business in their hands and away from those pesky federal regulations)ronthompson

Jindal wants to look like the Republican Hero that found a way to repeal or otherwise stop Obamacare. Then he will use this as his major campaign plank in his bid for the Republican nomination. So, is this ploy going to work?

Of course not. Our SOLD Legislators may let him get away with these illegal acts, but like the State Courts, the Federal government will NOT play his self serving games upon the backs of those least among us. And for you Christians, you know who said he was going to give a “butt whuppin'”
(secular terminology)to those that do evil to the least among us!

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